Brachial Plexus Injury : Prioritization Improves Outcome at High Volume Centers
Sunil Gaba, MS, MCh
PGIMER, Chandigarh, India
Introduction : Brachial plexus injury requires prolonged treatment and rigorous follow up from both the doctor and the patient. In spite of this it is challenging to get the desired results. In this study we present our experience in treating BPI over two years and our approach for improving the results.
Method : We did retrospective analysis of brachial plexus injury patients those operated between Jan 2014 to December 2015. We received a total of 107 primary brachial plexus injury cases from Jan 2014 to December 2015. Out of which 88 were operated during this 24 month period.
Based on level of injury
Based on Time since injury
Results : Out of the 52 cases of SA to SSN transfer 25 had M4 power(49.1%) and 17 had M3 grade power(33%).Out of the 35 cases who underwent Oberlin transfer 16 had M4 power (45%)elbow flexion average 100* & 13 had M3 power with average elbow flexion 70*. Out of the 27 patients who underwent ICN to MCN, SA to MCN, Phrenic to MCN neurotisation 14 patients had M3+ power (51.8%) and 4 patients had M3 power(14.8%) and 2 patient(6%) had M2 power. Out of eight FFMT patients, 5 patients got M4 power (66.7%) and 1 got M3 the remaining 1 had M2 grade as per MRC grading
Discussion : We identified patients who were likely to benefit most from the surgery based on the previous studies and experience. Cases which were likely to improve spontaneously (suspected traction injury) were operated only after a 3 month waiting period if they did not show any improvement. On the other hand cases with suspected avulsion injury were operated at the earliest possible time.
Result are better for nerve transfers if patients < 40 years age having C5, C6 C7 injuries and pan BPI presenting early ie within 3-12 months (Within this patients with upper trunk injury had better results) as compare to patients >40 yr age having C5, C6 C7 injuries and pan BPI presenting within 3 to 12 months.
For FFMTgroup also young Patients <40yrs have better Results
Conclusion : The selecting the right patient and intervening at the right time can give good results in this otherwise challenging injury.
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